Elective Stoma Construction Improves Outcomes in Medically Intractable Pressure Ulcers

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• 作者：SebastianG. de la Fuente ; L.Scott Levin ; JamesD. Reynolds ; Carmen Olivares ; TheodoreN. Pappas ; KirkA. Ludwig and ChristopherR. Mantyh
• 关键词：Decubitus ulcer ; Pressure ulcer ; Colostomy ; Ileostomy ; Laparoscopy ; Spinal cord injuries ; Quality of life
• 刊名：Diseases of the Colon & Rectum
• 出版年：2003
• 出版时间：November 2003
• 年：2003
• 卷：46
• 期：11
• 页码：1525-1530
• 全文大小：632 KB
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Surgery
  Gastroenterology
  Oncology
  Surgical Oncology
  Colorectal Surgery
  
• 出版者：Springer New York
• ISSN：1530-0358

文摘

PURPOSE: Perineal pressure ulcers are a common and devastating complication for paralyzed or chronically bedridden patients. Controversy exists on the benefit of fecal diversion for the treatment and prevention of these ulcers. This study compared outcomes in bed-bound patients with pressure ulcers who electively underwent fecal diversion with those who did not. METHODS: A retrospective review was performed on all disabled patients who underwent surgery for medically intractable pressure ulcer from 1993 to 2001. Charts were divided into the colostomy group or noncolostomy group. Recurrence rates, healing times, morbidity and mortality, and number of reoperations were calculated for each group. Additionally, stoma patients were interviewed for quality of life assessment. RESULTS: Sixty-seven patients were treated during the study period (colostomy, n = 41; noncolostomy, n = 26). The majority of colostomies were performed laparoscopically, with a 9.7 percent incidence of postoperative complications. The ulcer recurrence rate was lower in the treated colostomy group (43 percent) compared with the noncolostomy group (69 percent; P < 0.05). In addition, noncolostomy patients had longer healing times (7 vs. 3 months; P < 0.05), and this group required more ulcer operations than the stoma patients did. Quality of life and bowel care were much improved by the colostomy. CONCLUSIONS: Stoma construction is a safe procedure with low morbidity and mortality that helps heal pressure ulcers and decreases the incidence of recurrence. Additionally, laparoscopic stoma construction represents a technical advance that may reduce operative complications that have been previously reported with open fecal diversion.